I thought I wanted to harm my baby: why we must talk about postnatal anxiety and OCD

I stopped sleeping the day I had my son.

With the adrenaline of childbirth still surging through my body, I thought this postnatal insomnia would last a few weeks at most. But it didn’t.

Every time I lay my head down during one of his naps, my body would jerk itself awake in a rush of pure panic the second I started to nod off.

One evening, while my baby slept peacefully and my husband was out fetching supplies, I had a sudden visualisation of stabbing him with one of my used blood thinning injections.

A tidal wave of terror seized my body — I loved him to bits and wouldn’t want him harmed by anything. I took the needle bin and stood on a stool to put it out of reach on the highest shelf in my wardrobe.

The next day, as I walked across the landing on the upper floor of our house, I suddenly thought about throwing my son down the stairs and burst into tears.

What was happening to me?

I was assigned a perinatal (during or one year after birth) health nurse and then assessed by a consultant psychiatrist, who concluded that I was suffering from postpartum anxiety and OCD.

“Our survival mechanisms start to work overtime in order to keep mother and baby safe. We call this the ‘threat drive’ which is our oldest emotional system designed to help us survive”

This can happen if someone is still affected by hormonal changes during pregnancy, which can last for up to a year and beyond, says NHS mental health therapist Roban Diveney-Clegg.

“Our survival mechanisms start to work overtime in order to keep mother and baby safe. We call this the ‘threat drive’ which is our oldest emotional system designed to help us survive,” she says.

“Therefore, mothers may find themselves on high alert for any dangers in their environment that could cause harm to baby; this may include themselves.”

Postpartum OCD is when these worries and anxieties become intrusive thoughts, which then become an obsession.

This is because of someone’s perception of what those thoughts might say about them, says Diveney-Clegg.

“The threat system tells us to be afraid of these thoughts, that we can’t cope with these thoughts, that we need to get rid of them,” she adds. “The more we try to do that, the more they occur because our threat system tell us these thoughts are a danger we need to keep thinking about.”

I started to look at my intrusive thoughts as my brain’s broken way of trying to warn me of the things I should not do

In my case, it took a long and gruelling six months of taking antidepressants, working hard during therapy, and reading books by Dr Claire Weekes to reach where I am now – close to complete recovery and enjoying life again.

I started to look at my intrusive thoughts as my brain’s broken way of trying to warn me of the things I should not do. I started thanking my brain – yes, that’s right! – for looking out for me.

But I can’t help but feel that pregnant people need to be made more aware about childbirth-related mental illnesses that aren’t postnatal depression.

During my pregnancy, every medical professional I encountered, from my midwife to my obstetrician, warned me to look out for signs of postnatal depression, but no one had mentioned the possibility of postnatal anxiety and OCD.

And yet, the experience is fairly common. One US study published last year found that 7.8% of cisgender women in their study had OCD during pregnancy, which increased to 16.9% in the postnatal period.¹

Despite this, current psychiatric guidelines in the US do not recommend screening perinatal women specifically for OCD. Plus, the study authors note that standard assessments for OCD revolve around stereotypical symptoms such as obsessions with cleanliness and order, rather than intrusive thoughts.²

Because postnatal depression is so common and widely known, it’s often used as an umbrella term for a range of mental illnesses

One of the few studies done in Britain suggests that 4-9% of cis women in the postnatal period experience OCD, with one woman presenting with a case of perinatal OCD per full-time GP in the country per year.³

So why the radio silence on the condition? One explanation could be that because postnatal depression is so common and widely known, it’s often used as an umbrella term for a range of mental illnesses, says Diveney-Clegg.

This, on top of the stigma around mental health and motherhood, may mean that postpartum OCD is underreported.

Plus, the overlap in symptoms between low mood, anxiety, OCD, and other conditions can lead to misdiagnosis — but NHS psychologist Mohammed Yousif says that the NHS is working hard on improving their psychiatric assessments of pregnant and postnatal people.

The simple act of chatting with other mothers who would open up about their own mental health struggles made me realise that many new mothers experienced constant high levels of anxiety and intrusive thoughts

“When assessing a client, I would often assess for all possible diagnoses, and would use measures and questions more specific to new mothers. I believe services are becoming more adept at providing more tailored support.”

But while different conditions may share symptoms, there can also be an overlap in treatments that can help, so offering any kind of support can be beneficial, he adds.

One of the things that aided my recovery was joining my local mother and baby group. No matter how anxious I was feeling, I would force myself to go with my son.

The simple act of chatting with other mothers who would open up about their own mental health struggles made me realise that many new mothers experienced constant high levels of anxiety and intrusive thoughts.

However, while I recognised my symptoms and sought help straight away, many of the mothers I spoke to did not.

“Mothers often talk about feeling relieved when they open up to other people about how they feel, especially other mums, who may feel the same,” says Diveney-Clegg. “The earlier a problem with anxiety and/or OCD is detected, the easier it is to treat.”
 
 
For more information about postnatal OCD, visit the Royal College of Psychiatrists website
 
 
Featured image is an illustration of a woman sitting on the ground and leaning against the wall. She is in a crouched position and her hands are clutching her chest, as if she’s distressed. She is wearing a black hijab
 
 
Page last updated July 2022